The Network System of Insurance
Today’s health insurance companies typically charge customers for access to their networks – large groups of healthcare providers which include general practitioners, surgeons, specialists, and various hospitals and clinics. The main benefit of this type of system is that customers are able to get low-cost healthcare. However, additional complications and fees often come into play for people who need treatment outside their providers’ networks.
This can be a particularly difficult situation for people who need drug rehab. Addiction treatment is a highly-specialized part of the healthcare industry, and provider networks don’t always include a wide variety of readily-available rehab clinics. Still, Aetna insurance provides customers with a few different options for extra-network care.
Making Compromises with HMO Contracts
Health Maintenance Organizations – or HMOs – are organizations within Aetna which require customers to select primary care physicians. These physicians typically administer routine check-ups, but they are also responsible for making referrals to other in-network providers.
When addicts with these types of contracts want to attend rehab clinics outside their networks, they often have to pay most or all of the costs out of their own pockets. HMOs are the cheapest plans available, but they are also the most rigid. However, there is a loophole which allows people to affordably attend clinics outside their normal networks: some states require that insurance companies pay for certain treatments when the nearest relevant specialist or clinic is too far from a patient’s home.
The Flexibility of PPO Aetna Insurance for Rehab
Preferred Provider Organizations are more expensive, but they offer addicts more choices of rehab clinics and addiction specialists. They typically have larger networks than HMOs, and they may also cover thirty to seventy percent of the costs of out-of-network care. Many states have even capped the percentages which all PPOs can reduce their coverage, effectively ensuring that insurance companies won’t deny necessary funding to their addicted customers.
PPOs can also be helpful for addicts with co-occurring mental disorders. For instance, a depressed rehab patient might want to work with a specific psychiatrist outside their network. They may also want to attend a certain rehab clinic which offers integrated care – the simultaneous treatment of addiction and mental illness. The flexibility of Aetna PPO insurance allows them to pursue these treatments without incurring excessive costs.
Point-of-Service – A Decent Option for Addicts?
Point-of-Service plans don’t require that people select primary care physicians, but it is usually advised for them to do so. Although POS plans don’t provide coverage when customers seek their own out-of-network treatments, they will pay for them when they are accompanied by a primary physician’s referral. This option can be life-saving for addicts whose networks don’t include rehab clinics – or who live too far from the ones within their networks.
Addiction is a crippling disease, and you should seek out the best treatments possible to make a lasting recovery. Fill out the verification form to the right of this page with your Aetna insurance information, and find out the different ways you can get coverage for a drug rehab program.